Capitol Letters: Iowa Legislature prioritizes rural health care

State Rep. Megan Jones

As rural populations age and decrease, providing health care requires unique solutions to attract health care workforce and ensure a stable business model. We are not only focusing on helping Iowa’s rural communities thrive but also to ensure access to quality health care in all corners of the state.

Iowa has been awarded $209 million from the One Big Beautiful Bill in the first year of a five-year grant program, with over $1 billion expected to come to the state to help with rural health care access. Iowa’s Rural Health Transformation Plan is titled Healthy Hometowns and has five initiatives, with a major initiative being Combat Cancer: Prevent and Treat. The cancer initiative will invest $183 million to increase screening access, University of Iowa Cancer analyses, cancer hubs, and radon mitigation. This website includes all information about Iowa’s RHTP and includes an interactive dashboard to show where all funds have been distributed in the first year.

In addition to the $209 million being invested this year, the legislature has passed many bills this general assembly focused on rural health care. Below are some of those bills:

Medical Residencies - HF 2782, the FY 27 HHS Budget, provides $9.3 million in one-time funds as well as $1.5 million of ongoing funds for start-up grants for medical residencies located outside of Johnson County and that are not family medicine.

University of Iowa Health Care – HF 516 focuses our state institution and medical school on growing the physician workforce for the entire state. This bill requires the University of Iowa medical school and dental school to have at least 80% of their students be residents of Iowa, as well as priority admission to residents of Iowa who apply to these programs. This bill also requires specific questions regarding upbringing and intent to practice in Iowa by applicants for these programs as well as residency programs at UIHC. This bill requires an annual report by UI regarding the same schools and UIHC medical residencies demographic information.

This bill requires the University of Iowa Hospital and Clinics to offer an interview for the medical residencies of some of the most-needed specialties in Iowa to those with an Iowa connection.

This bill codifies requirements that were placed into session law in 2019 in House File 532. Additionally, it adds fellowships to the requirement that UIHC prioritize Iowans.

• Requires medical residencies at the University of Iowa Hospitals and Clinics to give priority to applicants that have an Iowa connection (resident of Iowa, went to undergrad in Iowa, or medical school in Iowa).
• Requires primary care residencies (family medicine, OB, psych, and internal medicine) at UIHC to provide the opportunity to participate in a rural rotation to expose those medical residents to rural areas of Iowa.

Prior Authorizations and Certificate of Need – HF 2635 makes the following changes to insurance and health care providers relationships, as well as certificate of need laws.

• Allows insurers to use AI for an initial prior auth review request, except for prior auth for medical necessity denials
• Provides timelines for audits in private insurance and requires insurers to negotiate with providers
• Prohibits private insurance from imposing a financial penalty, reimbursement reduction, administrative fee, or terminating participation in network based on the health care provider’s referral to an out-of-network health care provider
• Requires all prior auths to be submitted electronically starting July 1, 2027
• Prohibits private insurance from denying or downgrading a request for prior auth unless a qualified reviewer or clinical peer within the same specialty makes the decision and a written statement is provided with specific reasons and coverage criteria.
• Prohibits private insurance and Medicaid from requiring prior authorization on cancer-related screenings and life-threatening conditions
• Increases the threshold to apply for a certificate of need for a new health service/equipment and removes some services from needing CON. Iowa’s Rural Health Transformation Plan application included some of these changes to CON.

EMS – SF 2472 allows counties to double the amount of funds collected to go toward emergency medical services.

Subacute - House File 2543 makes the following changes based on the subacute mental health facility interim committee:

• Removes the 10-day limit
• Requires the development of a treatment plan within 24 hours of admission in a subacute facility
• Speeds up current law on prior authorization response times in Medicaid for subacute
• Establishes a PMIC bed tracking system
• Requires DHHS and DIAL to review rules to remove barriers to subacute care to ensure they are less stringent than the mental health institutes
• Requires DHHS to review the state’s capability to establish subacute mental health services and additional inpatient services at Independence MHI

Direct Primary Care – HF 2434 prohibits a health insurer from denying a covered benefit or applying higher cost sharing for a covered benefit solely because there was a referral made by a primary care provider not in-network with the insurer.

UIHC Noncompetes – HF 2254 prohibits noncompete agreements for physicians, ARNPs, PAs, pharmacists and nurses at the University of Iowa Hospitals and Clinics.

Governor Health Care Bill – HF 972 came from the Governor to do the following:

• Require DHHS to request federal approval for a health care hub-and-spoke partnership funding model to establish regional collaboration between health care providers in rural areas
• Consolidated five health care loan repayment programs into one called the Health Care Professional Incentive Program within DHHS that will award loan forgiveness or bonuses based on high-need health care professions in shortage areas. Provides for transition of funds to continue to support those with existing awards.
• Repeal existing residency and fellowship programs, with transition provisions, and converts those programs to the Medicaid graduate medical education efforts. The Governor has said that this will create a projected 115 new residency slots at our 14 training hospitals and will bring 460 new physicians to Iowa in four years.
• Eliminates the Health Facilities Council and replaces it with DHHS as the decision maker regarding certificate of need
• Requires DHHS to bid out the Iowa Health Information Network

Loan Forgiveness – SF 647 consolidated health care loan forgiveness programs into one program and increased funding from $4.2 million to almost $8 million.

Medical Licensing – SF 2184 extends the timeframe between license renewal and requires license applications to be responded to in certain timeframes when applying for a physician license with the Board of Medicine.

UNI Nursing Program – HF 2772 provided UNI $600,00 from the Skilled Worker and Job Creation Fund to expand their nursing education program

Contact Rep. Megan Jones by email: megan.jones@legis.iowa.gov